| NPI | 1639312457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR MD163403) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: OR MD163403) |
| 2083P0901X Preventive Medicine, Public Health & General Preventive Medicine (Licence: OR MD163403) | |
| Enumeration Date | 2009-04-09 |
| Last Update Date | 2022-06-16 |